title: An evaluation of whether neoadjuvant therapy delays closure of defunctioning loop ileostomy following anterior resection for rectal cancer.
abstract: OBJECTIVE
  The aim of this study was to determine whether neoadjuvant therapy delays the closure of loop ileostomy after anterior resection.
  
  
  METHODS
  Review of 45 patients with loop ileostomies formed at elective surgery from 2006- 2008. T-tests and Kaplan Meier survival analysis were used.
  
  
  RESULTS
  At a mean follow-up of 470 days 71% (N.=32) of patients have had their ileostomy closed. Of these, 27% (N.=12, group A) proceeded straight to surgery and 63% (N.=20, group B) received neoadjuvant therapy (long course chemoradiotherapy N.=13, short course radiotherapy N.=7). There was no significant difference in time to closure between groups (group A 181 days [range 98-296]; group B was 202 days [range 98-310], P=0.416). Those with Dukes C/D disease had a longer time to closure than those with A/B (P=0.002), likely due to higher complication rates in those with Dukes C/D disease (9/20 versus 4/25, P=0.049, respectively). Cox's regression analysis showed that only Dukes C/D stage was predictive of a longer time to closure (hazard ratio 3.289, 1.509-7.170, P=0.001).
  
  
  CONCLUSIONS
  Time to closure of loop ileostomy was not delayed by neoadjuvant therapies. Patients with Dukes C/D disease should be warned about risk of longer time to closure.
authors.affiliation: Department of Colorectal Surgery, Good Hope Hospital, Birmingham, UK. aneelbhangu@doctors.org.uk
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
authors.forename: R
authors.initials: R
authors.lastname: Tiramula
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects* / Q000528:radiation effects*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil